A brief description about Periodontal Pocket , Gingival Recession , Tooth mobility

1. PERIODONTAL POCKET
GINGIVAL RECESSION &
TOOTH MOBILITY

2. PERIODONTAL POCKET
• A periodontal pocket is defined as
the pathologically deeped gingival sulcus.
• Deepening of gingival sulcus may occur by
coronal movement of gingival margin, apical
displacement of gingival attachment.

3. CLASSIFICATION
Gingival pocket Periodontial pocket
Suprabony pocket Infrabony Pocket

4. Gingival Pocket
• It is formed by gingival enlargement
without destruction of underlying
peridontal tissue.
• The sulcus is deepend because of the
increased bulk of gingiva.
• Seen in gingivitis
Periodontal Pocket
• It produces destruction of supporting
periodontal tissue
• It leads to the loosening and
exfoliation of the teeth.
• Seen in peridontitis

5. Suprabony Pocket
• Base of pocket coronal to the crest of
alveolar bone.
• Horizontal bone loss.
• PDL fibres follow their normal horizontal -
oblique course between the tooth and the
bone
Infrabony Pocket
• Base of pocket is apical to the crest of
alveolar bone .
• Vertical bone loss
• PDL fibres follow angular pattern of the
adjacent bone .

6. PATHOGENISIS
Bacterial challenge : Diseased gingiva is associated with increased number of spirochetes .
Pocket formation starts as inflamatory in connective tissue wall of gingival sulcus
Formation of inflammatory exudate
Degeneration of surrounding connective tissue including gingival fibres
Just apical to the junctional epithelium , collagen fibres are destroyed and the area is occupied by
inflammatory cells

7. HISTOPATHOLOGY
1. Epithelium :
Densely infiltrated by leukocytes and edema .
Vascular degeneration
Ulceration of suppuration
2. Connective Tissue :
Edemmatous and densely infiltrated with plasma
cells lymphocytes and scattering of PMNs.
Blood vessels
Degenerative changes

8. CLINICAL FEATURES
• Bluish red discoloration
• Flaccidity
• Smooth and shinny surface
• Pink and firm gingival wall
• Bleeding
• Inner aspect of the pocket is painful
• Puss may be expressed out

9. PERIODONTAL POCKET CONTAINS
• Microorganism
• Gingival Fluid
• Food remment
• Salivary Musin
• Leukocytes
ROOT SURFACE WALL
• As the pockets deepens the cementum bocomes exposed to oral
environment .
• Collageneous remnents of sherpey fibres in the cementum
degenerates
• Penetration of bacteria results in fragmentation and breakdown of
cementum surface results in area of necrotic cementum.

10. TREATMENT
• Root planing
• Scanling
• Educating the pateint about oral hygine practices and habbit
changes

11. GINGIVAL RECESSION
• It is defined as the apical shift of the marginal gingiva for its normal position to
beyond the CEJ.
• Approx. 88% of people of from the age group >= 65yr have gingival recession
in one or more sites.
• Approx. 50% of people from the age group 18-64 yrs had gingival recession in
one or more sites.

12. CLASSIFICATION (Acc. to
Sullivan and Atkins )
• Deep Wide
• Shallow Wide
• Deep Narrow
• Shallow Narrow
Drawback : Doesn't enable clinician to
predict the outcome of therapy

13. CLASSIFICATION (Acc. to P.D.
Miller)
• Class 1:
1. Tissue recession with the attacted gingiva.
2. no bone or soft tissue loss
• Class 2 :
1. Recession extends to or beyond
mucogingival junction.
2. no bone or soft tissue loss
• Class 3 :
1. Extends beyond MGJ
2. partial bone and soft tissue loss
3. partial root coverage expected
• Class 4 :
1. Extends beyond MGJ

14. ETIOLOGY
• Anatomical Factor : Abnormal tooth position
Thin gingival biotype
High frenum attachment
• Pathological Factor : Periodontal Disease
Bacterial Plaque
Dental Calculus
• Traumatic Factor : Tooth brushing
Flossing
• Iatrogenic Factor : Orthodontic Treatment
Restorative and prosthetic Treatment

15. TECHNIQUE FOR ROOT COVERAGE
• Free gingival autograft
• Connective tissue autograft
• Subepithelial connective tirssue graft
• GTR produces
• Pouch &Tunnel's procedure
• Pedicle autograft
• laterally positioned
• Coronally positioned flap

16. TOOTH MOBILITY
Introduction
• Kenry AAP 1986 : It is defined as the degree of looseness of tooth .
• It is the movement of tooth in the socket resulting from an applied force .
• Mobility occures in two stages :
- Initial Stage
- Secondary stage

17. Types of Tooth Mobility :
• Physiologic : Moderate force exerted on the tooth surrounded by a healthy
peridontium and tooth shows tipping movement .
• Pathological : Any degree of movement perceived either faciolingually , mesiodistally
or axially when force is applied .
Factors for Pathological Tooth Mobility :
• Extent of inflammation
• Loose of tooth support
• Trauma from occlusion
• Periodontial Injury
• Pathologic process of the jaw

18. Classification (By Miller) :
• Class 0 : No movement on application of force
• Class 1 : Tooth movement is barely distinguishable.
• Class 2 : Tooth movement in any direction .
• Class 3 : Tooth movement in any direction tooth is depressible in the socket .
Classification (By Carranza) :
• Grade 1 : Slightly more than normal
• Grade 2 : Moderately more than normal
• Grade 3 : Severly more than normal in faciolingual or mesiodistal direction
combination with vertical dispalacement

19. Method To Assess Tooth Mobility :
Use of Handle of Mouth Mirror Use of Handle of Mouth mirror
and Handle of Probe and Finger
Use of Fingers Use of Peridontiometer

20. Signs and Symptoms
• Patient awareness of mobility
• Functional discomfort
• Esthetic
Clinical Impact
• Various degree of gingival inflamation
• Loss of attachment
• Pocket Formation
• Gingival recession
Treatment :
• Splinting of Tooth
• By using Night Guard
• Correction of occlusal surface
• Replacement of missing tooth

21. THANK YOU